Background & Aims

Life stress is linked to disabling health conditions in older adults. Two factors thought to mediate relationships between life stress and disability are: 1) the accumulation of stress exceeding adaptive endogenous capability, known as ‘stress overload;’ and 2) the acute physiological response to social stressors, known as ‘social stress reactivity.’ Neither factor is well studied in older adults with low back pain (LBP), which is the most disabling pain condition among older adults worldwide. In this proof-of-concept study, we aimed to characterize stress overload and social stress reactivity in older adults with persistent LBP. An exploratory aim was to test associations among stress overload and social stress reactivity with pain intensity and pain catastrophizing.

Methods

32 older adults with persistent LBP attended a single laboratory session. Stress measures were stress overload via the 30-item Stress Overload Scale, and social stress reactivity via the Trier Social Stress Test (TSST). Social stress reactivity was defined as vital sign response (heart rate, systolic and diastolic blood pressure [BP]) to the TSST. Vital signs were measured at four time points: before, twice during (after speech and arithmetic tasks), and after the TSST. Pain measures were pain intensity via the 4-item Brief Pain Inventory, and pain catastrophizing via the 13-item Pain Catastrophizing Scale. Both measures were median split to explore high/low subgroups with stress reactivity. Descriptive statistics provided questionnaire scores. Spearman rank correlation examined relationships between pain intensity, pain catastrophizing, and stress overload. Repeated measures ANOVA tested social stress reactivity by total sample and high/low subgroups.

Results

Participants were 72 ± 7 years old; 78% identified as female and 34% identified as non-white. Mean pain intensity was 4.5 ± 1.7/10. Pain catastrophizing (mean 17 ± 10.4/52) was positively correlated with stress overload (mean 58 ± 16.4/120; Spearman (p) = 0.447, p=0.012). With the TSST, baseline heart rate increased by 9% (F2,62=7.9, p<0.001), baseline systolic BP by 21% (F2,62=62.4, p<0.001), and baseline diastolic BP by 13% (F2,62=24.8, p<0.001). Diastolic BP increased by 15% for participants with high pain intensity, versus 6% for those with low pain intensity (F2,29 = 3.0, p=0.064). Heart rate and Systolic BP were similar between pain intensity and catastrophizing subgroups (p>0.05).

Conclusions

Older adults with persistent LBP demonstrated evidence of stress overload and social stress reactivity. In this subpopulation, higher stress overload may be related to higher pain catastrophizing, while higher social stress reactivity related to higher LBP pain intensity.

References

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[3] Buchbinder R, Blyth FM, March LM, Brooks P, Woolf AD, Hoy DG. Placing the global burden of low back pain in context. Best Pract Res Clin Rheumatol 2013;27:575–589.
[4] Heckman W. Seniors and Stress. The American Institute of Stress n.d. Available: https://www.stress.org/seniors-and-stress. Accessed 28 Jan 2024.
[5] Makris UE, Fraenkel L, Han L, Leo-Summers L, Gill TM. Restricting back pain and subsequent mobility disability in community-living older persons. J Am Geriatr Soc 2014;62:2142–2147.
[6] Marshall LM, Litwack-Harrison S, Cawthon PM, Kado DM, Deyo RA, Makris UE, Carlson HL, Nevitt MC. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Women. J Gerontol Ser A-Biol Sci Med Sci 2016;71:1177–1183.

Presenting Author

Corey B. Simon

Poster Authors

Corey Simon, PT, DPT, PhD

DPT, PhD

Department of Orthopaedic Surgery, Duke University, North Carolina, USA

Lead Author

E-mail

Hanna Zhao

B.A.

Duke University

Lead Author

E-mail

Spencer Green

M.S.

Duke University

Lead Author

E-mail

Susan Girdler

PhD

University of North Carolina at Chapel Hill

Lead Author

E-mail

Cathleen Colón-Emeric

MD

Duke University

Lead Author

E-mail

Francis Keefe

Duke University

Lead Author

E-mail

Topics

  • Mechanisms: Biological-Systems (Physiology/Anatomy)